title: Plasma cytokines in paediatric typhoidal salmonellosis: correlation with clinical course and outcome.
abstract: We evaluated the clinical profile, outcome and serial plasma interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-alpha) concentrations in 38 consecutive children (aged 6 months-14 years) admitted with culture-proven multidrug-resistant typhoid. All children received therapy for 14 days with either i.v. ceftriaxone or oral cefixime, with comparable outcome. Concentrations of IL-6 and TNF-alpha were significantly elevated in over 50% of the cases and correlated with clinical severity of illness as quantitated by the typhoid morbidity score. Sequential measurements revealed a significant decrease in IL-6 and TNF-alpha concentrations within 7 days of initiation of therapy (P<0.05). While no clear relationship was seen with time-to-defervescence, the failure rate was significantly higher in children with baseline serum IL-6 values >400 pg/ml (P<0.05). Our data suggest that plasma cytokine activity is frequently elevated in children with typhoidal salmonellosis, and IL-6 concentrations show a correlation with clinical severity and recovery from the illness.
authors.affiliation: Department of Paediatrics, The Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Z A
authors.initials: ZA
authors.lastname: Bhutta
authors.forename: N
authors.initials: N
authors.lastname: Mansoorali
authors.forename: R
authors.initials: R
authors.lastname: Hussain
mesh_terms: D000293:Adolescent; D020682:Cefixime; D002439:Cefotaxime / Q000031:analogs & derivatives / Q000627:therapeutic use; D002443:Ceftriaxone / Q000627:therapeutic use; D002511:Cephalosporins / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D018432:Drug Resistance, Multiple; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007223:Infant; D015850:Interleukin-6 / Q000097:blood*; D008297:Male; D009017:Morbidity; D012485:Salmonella typhi / Q000187:drug effects / Q000276:immunology*; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis*; D014435:Typhoid Fever / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology*
chemical_list: D002511:Cephalosporins; D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha; D002443:Ceftriaxone; D020682:Cefixime; D002439:Cefotaxime